UT Physicians

Epilepsy surgery helps young woman get life back

By Darla Brown

After eight years of suffering with
epilepsy, Amanda Saenz, 24, is finally
living a normal life, seizure-free.
"I feel like my life is as normal as it can
be," Saenz says. "I got married in June, I
can drive now – I had to stop because I had
a seizure driving and drove my car into a
bayou. I'm going back to school, and I hope to
graduate in 2008.

"Seizures were a big part of my life, and
they are not there anymore."
Seizures have been erased from Saenz's
life thanks to epilepsy surgery and the comprehensive
epilepsy team of UT Physicians,
which offers a multidisciplinary approach to
epilepsy management and diagnosis.

"We have all of the components here,"
says Nitin Tandon, M.D., assistant professor
of neurosurgery. "We have neuroradiology,
neuropathology, neuropsychiatry, in addition
to neurologists and neurosurgeons."

Two percent of all Americans have seizures,
and half of these have epilepsy.

"A seizure is a short-circuit within the
brain, where an excessive number of brain
cells are firing at the same time," explains
Jeremy Slater, M.D., associate professor of
neurology and director of the Texas Comprehensive
Epilepsy Program at the UT Medical
School. "If the brain has changed in such
a way where seizures will happen, that is
called epilepsy. It's the second most common
neurological disease behind stroke."

Thirty percent of those with epilepsy
have refractory seizures that cannot be managed
with medications alone.

"About half of those may be candidates
for surgery," Dr. Slater says. "There are a lot
of patients out there who may benefit from
this surgery that we have so far not been able
to reach."

The field of epileptology has grown over
the last 50 years and now offers a variety of
treatments to patients, from new medications
now on the market to epilepsy surgery
and the implantation of vagus nerve stimulators.

"Medicine now has much to offer
patients suffering from epilepsy – it has
become much more sophisticated and successful
over the last half a century," says
James Ferrendelli, M.D., chair of the Department
of Neurology and past president of the
American Epilepsy Society who has published
many articles on the diagnosis and treatment
of epilepsy. "There are now hundreds of neurologists
and neurosurgeons specializing in
epileptology. The University of Texas Medical
School at Houston and Memorial Hermann
Hospital is recognized nationally and internationally
as a leading center for the diagnosis
and treatment of epilepsy."

Patients like Saenz undergo a three-phase
process when they enter the UT Physicians'
Epilepsy Program, which is one of the leading
centers in the country and is in growth
mode, adding specialists to meet the needs of
the citizens of Texas and surrounding states.

Phase 1 is a stay in the 12-bed Epilepsy
Monitory Unit (EMU) at Memorial Hermann Hospital, which is directed by Dr. Slater. Here
patients are monitored on video, hooked
up to electrodes, and encouraged to have a
seizure so that it can be mapped in the brain.

"I stayed in the EMU about 5 days, where
they monitored my brain waves and took
me off my medications and made me stay
up a whole night to try to get me to have a
seizure. Finally, I had one," Saenz recalls.

"After a patient has a seizure in the EMU,
we go back and look at the video and the EEG
(electroencephalogram) at the same time to
see if it is a focal or generalized seizure," Dr.
Tandon explains.

UT Physicians were able to determine if
Saenz's seizures were focal or generalized
and deduced that they were localized on her
right temporal lobe.

"The next step was a series of tests to see
where my memory and speech were located
on my brain," Saenz says.

These battery of tests are known as Phase
II and may include an MRI (Magnetic resonance
imaging), MEG (magnetoencephalogram), PET (positron emission tomography),
and SPECT (single photon computer tomography).

"These imaging tests help us map the
important speech, language, and memory
functions of the patient's brain. Everyone's
language area is in a slightly different place
in the brain, and there are several areas and
connective fibers between them. The areas of
the brain that control motor skills are more
predictable," Dr. Tandon explains.

"We create a map of these functions by
implanting electrodes on these specific locations
before the surgery – and we stay away
from them," Dr. Tandon adds.

Even though these areas of memory are
mapped prior to surgery, memory loss can
be a side effect of epilepsy surgery because
a diseased hippocampus is often removed
during the surgery. Because of this possibility,
Joshua Breier, Ph.D., associate professor of
neurosurgery, does testing of patients before
and after surgery for memory.

"We do two pre-surgical procedures with
these patients in addition to a full neuropsychological
evaluation," Dr. Breier explains.
"With the Wada test, we look at language and
memory function by putting one side of the
brain asleep for eight minutes and test the
other side, then vice versa.

"We can also map their brain extraoperatively
or intraoperatively if language is on the
same side of the brain that will be operated
on. We stimulate one of the grids sitting on
top of the brain and ask them to perform
language tests to gauge where the language
resides," Dr. Breier says.

Patients undergo a full neuropsychological
evaluation post-operatively as well.

"Following surgery, patients are often
completely free of daily or weekly seizures,
so it can be a large change in people's lives,
and we help them prepare for it psychologically
– usually things get better," Dr. Breier
adds.

Saenz says memory loss has not been a
problem for her since the surgery.

"I used to have memory problems before
the surgery, but I think epilepsy surgery has
served to prevent future memory problems
for me because of where the seizures were on
my brain," she says.

Saenz says her faculties were functioning
fine when her boyfriend, Rudy, proposed to
her just days after surgery while she was still
in the hospital.

"I was hoping surgery would open up
new doors to me, and it has," Saenz says.

For more information, or to refer a patient,
call 1.877.4UT.DOCS (1.877.488.3627).